健康な、健常な

関: health

WordNet

having or indicating good health in body or mind; free from infirmity or disease; "a rosy healthy baby"; "staying fit and healthy"
exercising or showing good judgment; "healthy scepticism"; "a healthy fear of rattlesnakes"; "the healthy attitude of French laws"; "healthy relations between labor and management"; "an intelligent solution"; "a sound approach to the problem"; "sound advice"; "no sound explanation for his decision" (同)intelligent, levelheaded, level-headed, sound
promoting health; healthful; "a healthy diet"; "clean healthy air"; "plenty of healthy sleep"; "healthy and normal outlets for youthful energy"; "the salubrious mountain air and water"- C.B.Davis; "carrots are good for you" (同)salubrious, good for you
financially secure and functioning well; "a healthy economy"
a healthy state of wellbeing free from disease; "physicians should be held responsible for the health of their patients" (同)wellness
the general condition of body and mind; "his delicate health"; "in poor health"

PrepTutorEJDIC

(人・身心などが)『健康な』,健全な / 『健康によい』,健康を増進する
『健康』,健全 / (体の)状態,調子 / 《To one's health!》(健康を祝しての)乾杯

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/14 11:32:17」(JST)

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[Wiki en表示]

This article is about the human condition. For other uses, see Health (disambiguation).

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind and body, usually meaning to be free from illness, injury or pain (as in "good health" or "healthy").^[1] The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."^[2]^[3] Although this definition has been subject to controversy, in particular as lacking operational value and because of the problem created by use of the word "complete", it remains the most enduring .^[4]^[5] Classification systems such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD), are commonly used to define and measure the components of health.

Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers. Applications with regard to animal health are covered by the veterinary sciences. The term "healthy" is also widely used in the context of many types of non-living organizations and their impacts for the benefit of humans, such as in the sense of healthy communities, healthy cities or healthy environments. In addition to health care interventions and a person's surroundings, a number of other factors are known to influence the health status of individuals, including their background, lifestyle, and economic and social conditions; these are referred to as "determinants of health".

Determinants of health

See also: Social determinants of health and Risk factor

Generally, the context in which an individual lives is of great importance for his health status and quality of life. It is increasingly recognized that health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society. According to the World Health Organization, the main determinants of health include the social and economic environment, the physical environment, and the person's individual characteristics and behaviors.^[6]

More specifically, key factors that have been found to influence whether people are healthy or unhealthy include:^[6]^[7]^[8]

Income and social status
Social support networks
Education and literacy
Employment/working conditions
Social environments
Physical environments

Personal health practices and coping skills
Healthy child development
Biology and genetics
Health care services
Gender
Culture

Donald Henderson as part of the CDC's smallpox eradication team in 1966.

An increasing number of studies and reports from different organizations and contexts examine the linkages between health and different factors, including lifestyles, environments, health care organization, and health policy - such as the 1974 Lalonde report from Canada;^[8] the Alameda County Study in California;^[9] and the series of World Health Reports of the World Health Organization, which focuses on global health issues including access to health care and improving public health outcomes, especially in developing countries.^[10]

The concept of the "health field", as distinct from medical care, emerged from the Lalonde report from Canada. The report identified three interdependent fields as key determinants of an individual's health. These are:^[8]

Lifestyle: the aggregation of personal decisions (i.e., over which the individual has control) that can be said to contribute to, or cause, illness or death;
Environmental: all matters related to health external to the human body and over which the individual has little or no control;
Biomedical: all aspects of health, physical and mental, developed within the human body as influenced by genetic make-up.

The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being, together sometimes referred to as the "health triangle".^[11]^[12] The WHO's 1986 Ottawa Charter for Health Promotion further stated that health is not just a state, but also "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."^[13]

Focusing more on lifestyle issues and their relationships with functional health, data from the Alameda County Study suggested that people can improve their health via exercise, enough sleep, maintaining a healthy body weight, limiting alcohol use, and avoiding smoking.^[14] The ability to adapt and to self manage have been suggested as core components of human health.^[15]

The environment is often cited as an important factor influencing the health status of individuals. This includes characteristics of the natural environment, the built environment, and the social environment. Factors such as clean water and air, adequate housing, and safe communities and roads all have been found to contribute to good health, especially to the health of infants and children.^[6]^[16] Some studies have shown that a lack of neighborhood recreational spaces including natural environment leads to lower levels of personal satisfaction and higher levels of obesity, linked to lower overall health and well being.^[17] This suggests that the positive health benefits of natural space in urban neighborhoods should be taken into account in public policy and land use.

Genetics, or inherited traits from parents, also play a role in determining the health status of individuals and populations. This can encompass both the predisposition to certain diseases and health conditions, as well as the habits and behaviors individuals develop through the lifestyle of their families. For example, genetics may play a role in the manner in which people cope with stress, either mental, emotional or physical. (One difficulty is the issue raised by the debate over the relative strengths of genetics and other factors; interactions between genetics and environment may be of particular importance.)

Mental health

Main article: Mental health

The World Health Organization describes mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".^[18]

Roughly a quarter of all adults 18 and over in the US suffer from a diagnosable mental disorder. Mental disorders are the leading cause of disability in the US and Canada. Examples of disorders include, schizophrenia, ADHD, major depressive disorder, bipolar disorder, anxiety disorder, post-traumatic stress disorder and autism.^[19]

Maintaining health

Achieving and maintaining health is an ongoing process, shaped by both the evolution of health care knowledge and practices as well as personal strategies and organized interventions for staying healthy.

Role of science in health

Main articles: Health science and Health care

The Dutch Public Health Service provides medical care for the natives of the Dutch East Indies, May 1946

Health science is the branch of science focused on health. There are two main approaches to health science: the study and research of the body and health-related issues to understand how humans (and animals) function, and the application of that knowledge to improve health and to prevent and cure diseases and other physical and mental impairments. The science builds on many sub-fields, including biology, biochemistry, physics, epidemiology, pharmacology, medical sociology. Applied health sciences endeavor to better understand and improve human health through applications in areas such as health education, biomedical engineering, biotechnology and public health.

Organized interventions to improve health based on the principles and procedures developed through the health sciences are provided by practitioners trained in medicine, nursing, nutrition, pharmacy, social work, psychology, occupational therapy, physical therapy and other health care professions. Clinical practitioners focus mainly on the health of individuals, while public health practitioners consider the overall health of communities and populations.Workplace wellness programs are increasingly adopted by companies for their value in improving the health and well-being of their employees, as are school health services to improve the health and well-being of children.

Role of public health

Main article: Public health

Self-care strategies

Main article: Self care

See also: Chronic care management, Social relation, and Stress management

A lady washing her hands c. 1655

Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. They also include personal hygiene practices to prevent infection and illness, such as bathing and washing hands with soap; brushing and flossing teeth; storing, preparing and handling food safely; and many others. The information gleaned from personal observations of daily living - such as about sleep patterns, exercise behavior, nutritional intake, and environmental features - may be used to inform personal decisions and actions (e.g., "I feel tired in the morning so I am going to try sleeping on a different pillow"), as well as clinical decisions and treatment plans (e.g., a patient who notices his or her shoes are tighter than usual may be having exacerbation of left-sided heart failure, and may require diuretic medication to reduce fluid overload).^[24]

Personal health also depends partially on the social structure of a person's life. The maintenance of strong social relationships, volunteering, and other social activities have been linked to positive mental health and even increased longevity. One American study among seniors over age 70 found that frequent volunteering was associated with reduced risk of dying compared with older persons who did not volunteer, regardless of physical health status.^[25] Another study from Singapore reported that volunteering retirees had significantly better cognitive performance scores, fewer depressive symptoms, and better mental well-being and life satisfaction than non-volunteering retirees.^[26]

Prolonged psychological stress may negatively impact health, and has been cited as a factor in cognitive impairment with aging, depressive illness, and expression of disease.^[27] Stress management is the application of methods to either reduce stress or increase tolerance to stress. Relaxation techniques are physical methods used to relieve stress. Psychological methods include cognitive therapy, meditation, and positive thinking, which work by reducing response to stress. Improving relevant skills, such as problem solving and time management skills, reduces uncertainty and builds confidence, which also reduces the reaction to stress-causing situations where those skills are applicable.

Occupational health

Main article: Occupational health and safety

In addition to safety risks, many jobs also present risks of disease, illness, and other long-term health problems. Among the most common occupational diseases are various forms of pneumoconiosis, including silicosis and coal worker's pneumoconiosis (black lung disease). Asthma is another respiratory illness that many workers are vulnerable to. Workers may also be vulnerable to skin diseases, including eczema, dermatitis, urticaria, sunburn, and skin cancer.^[28]^[29] Other occupational diseases of concern include carpal tunnel syndrome and lead poisoning.

As the number of service sector jobs has risen in developed countries, more and more jobs have become sedentary, presenting a different array of health problems than those associated with manufacturing and the primary sector. Contemporary problems such as the growing rate of obesity and issues relating to stress and overwork in many countries have further complicated the interaction between work and health.

Many governments view occupational health as a social challenge and have formed public organizations to ensure the health and safety of workers. Examples of these include the British Health and Safety Executive and in the United States, the National Institute for Occupational Safety and Health, which conducts research on occupational health and safety, and the Occupational Safety and Health Administration, which handles regulation and policy relating to worker safety and health.^[30]^[31]^[32]

References

^ Merriam-Webster. Dictionary - "Health", accessed 21 April 2011.
^ World Health Organization. 1946. WHO definition of Health, Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
^ World Health Organization. 2006. Constitution of the World Health Organization - Basic Documents, Forty-fifth edition, Supplement, October 2006.
^ Callahan D. "The WHO definition of 'health'." The Hastings Center Studies, 1(3), 1973 - http://www.jstor.org/pss/3527467
^ Jadad AR, O'Grady L. "How should health be defined?" BMJ 2008; 337:a2900 - http://www.bmj.com/cgi/content/full/337/dec10_1/a2900
^ ^a ^b ^c World Health Organization. The determinants of health. Geneva. Accessed 12 May 2011.
^ Public Health Agency of Canada. What Determines Health? Ottawa. Accessed 12 May 2011.
^ ^a ^b ^c Lalonde, Marc. "A New Perspective on the Health of Canadians." Ottawa: Minister of Supply and Services; 1974.
^ Housman, Jeff; Dorman, Steve (September/October 2005). "The Alameda County Study: A Systematic, Chronological Review" (PDF). American Journal of Health Education (Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance) 36 (5): 302–308. ISSN 1055-6699. ERIC document number EJ792845. http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=EJ792845. Retrieved 27 December 2011.
^ World Health Organization. The world health report. Geneva.
^ Georgia State University. 1998. Health Triangle Slides.
^ Nutter S. 2003. The Health Triangle. Anchor Points, Inc.
^ World Health Organization. The Ottawa Charter for Health Promotion. Adopted at the First International Conference on Health Promotion, Ottawa, 21 November 1986 - WHO/HPR/HEP/95.1.
^ Housman & Dorman 2005, pp. 303–304. "The linear model supported previous findings, including regular exercise, limited alcohol consumption, abstinence from smoking, sleeping 7-8 hours a night, and maintenance of a healthy weight play an important role in promoting longevity and delaying illness and death." Citing Wingard Dl, B. L.; Berkman, L. F.; Brand, R. J. (1982). "A multivariate analysis of health-related practices: a nine-year mortality follow-up of the Alameda County Study". Am J Epidemiol 116 (5): 765–775. PMID 7148802. edit
^ Huber M et al. "How should we define health?" BMJ 2011;343 doi:10.1136/bmj.d4163 (Published 26 July 2011). Accessed 2 August 2011.
^ UNESCO. The UN World Water Development Report: Facts and Figures - Meeting basic needs. Accessed 12 May 2011.
^ Bjork J et al. "Recreational Values of the Natural Environment in Relation to Neighborhood Satisfaction, Physical Activity, Obesity and Well being." J Epidemiol Community Health 2008;62:e2
^ World Health Organization (2050). Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. World Health Organization. Geneva.
^ The numbers count: Mental disorders in America retrieved 5 September 2012
^ C.-E. A. Winslow. 1920. "The Untilled Fields of Public Health," Science, n.s. 51.
^ Association of Schools of Public Health. What is Public Health? Retrieved 2010-06-24
^ Association of Schools of Public Health. Impact of Public Health. Retrieved 2010-6-24.
^ World Health Organization. Life expectancy at birth, accessed 20 April 2011.
^ Robert Wood Johnson Foundation. 2008. Health in Everyday Living.
^ Harris AHS, Thoresen CE. "Volunteering is Associated with Delayed Mortality in Older People: Analysis of the Longitudinal Study of Aging." Journal of Health Psychology, 2005; 10(6): 739–752.
^ Schwingel A et al. "Continued work employment and volunteerism and mental well-being of older adults: Singapore longitudinal ageing studies." Age and Ageing, 2009; 38(5): 531-537.
^ McEwen BS (2006). "Protective and damaging effects of stress mediators: central role of the brain". Dialogues Clin Neurosci 8 (4): 367–81. PMC 3181832. PMID 17290796. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3181832/.
^ HSE (Health and Safety Executive of Great Britain) Skin at work Retrieved on June 20, 2009
^ "Skin Exposure & Effects". NIOSH Topics. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/topics/skin/. Retrieved 7 August 2012.
^ "The National Institute for Occupational Safety and Health". Centers for Disease Control and Prevention. http://www.cdc.gov/niosh/. Retrieved 7 August 2012.
^ "Occupational Safety and Health Administration". U.S. Department of Labor. http://www.osha.gov/. Retrieved 7 August 2012.
^ "Health and Safety Executive". U.K. Health and Safety Executive. http://www.hse.gov.uk/. Retrieved 7 August 2012.

External links

Look up health in Wiktionary, the free dictionary.

Wikiquote has a collection of quotations related to: Health

World Health Organization
UK National Health Service
Health On the Net Foundation
OECD Health Statistics
Health and Medical Information from the University of Colorado
Health-EU Portal, public health portal of the European Union

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 健康な新生児のルーチンのマネージメントの概要 overview of the routine management of the healthy newborn infant
2. 好酸球の生物学および好酸球増多症の原因 eosinophil biology and causes of eosinophilia
3. 患者情報：食事と健康（詳細） diet and health beyond the basics
4. Sleep-wake disturbances and sleep disorders in patients with dementia
5. 思春期における多嚢胞性卵巣症候群の診断的評価 diagnostic evaluation of polycystic ovary syndrome in adolescents

English Journal

Factors associated with bone mineral density in healthy African women.

Mgodi NM1, Kelly C, Gati B, Greenspan S, Dai JY, Bragg V, Livant E, Piper JM, Nakabiito C, Magure T, Marrazzo JM, Chirenje ZM, Riddler SA; MTN-003B Protocol Team.
Archives of osteoporosis.Arch Osteoporos.2015 Dec;10(1):206. doi: 10.1007/s11657-015-0206-7. Epub 2015 Feb 14.
There is a paucity of normative bone mineral density (BMD) data in healthy African women. Baseline total hip and lumbar spine BMD was measured in premenopausal women. BMD distribution was comparable to that of a reference population and was impacted by several factors including contraception and dur
PMID 25680424

Vertebral fracture prevalence in black and white South African women.

Conradie M1, Conradie MM, Scher AT, Kidd M, Hough S.
Archives of osteoporosis.Arch Osteoporos.2015 Dec;10(1):203. doi: 10.1007/s11657-015-0203-x. Epub 2015 Feb 13.
Black women are generally regarded as being less prone to the development of osteoporosis. This study reports a similar prevalence of morphometric vertebral fractures in black (9.1 %) and white (5.0 %) South African women. Clinical risk factors and bone strength parameters contributed differently
PMID 25675880

Reasons why dynamic compression plates are inferior to locking plates in osteoporotic bone: a finite element explanation.

MacLeod AR1, Simpson AH, Pankaj P.
Computer methods in biomechanics and biomedical engineering.Comput Methods Biomech Biomed Engin.2015 Dec;18(16):1818-25. doi: 10.1080/10255842.2014.974580. Epub 2014 Dec 4.
While locking plate fixation is becoming increasingly popular for complex and osteoporotic fractures, for many indications compression plating remains the standard choice. This study compares the mechanical behaviour of the more recent locking compression plate (LCP) device, with the traditional dyn
PMID 25473732

Gaussian modeling of the P-wave morphology time course applied to anticipate paroxysmal atrial fibrillation.

Martínez A1, Alcaraz R, Rieta JJ.
Computer methods in biomechanics and biomedical engineering.Comput Methods Biomech Biomed Engin.2015 Dec;18(16):1775-84. doi: 10.1080/10255842.2014.964219. Epub 2014 Oct 9.
This paper introduces a new algorithm to quantify the P-wave morphology time course with the aim of anticipating as much as possible the onset of paroxysmal atrial fibrillation (PAF). The method is based on modeling each P-wave with a single Gaussian function and analyzing the extracted parameters v
PMID 25298113

Japanese Journal

Estrogen deficiency heterogeneously affects tissue specific stem cells in mice

Kitajima Yuriko,Doi Hanako,Ono Yusuke,Urata Yoshishige,Goto Shinji,Kitajima Michio,Miura Kiyonori,Li Tao-Sheng,Masuzaki Hideaki
Scientific Reports 5, 12861, 2015-08-06
… Sham-operated mice were used as healthy controls. … Compared with the healthy control, ovariectomy significantly decreased uterine weight, which was partially recovered by 17β-estradiol replacement. …
NAID 120005649209

身体表現活動における羞恥心の要因の検討に有効な質問項目の選択

杉浦宏季,Sugiura Hiroki,橘和代,Tachibana Kazuyo,横谷智久,Yokoya Tomohisa,野口雄慶,Noguchi Takanori
福井工業大学研究紀要, 264-267, 2015-08-06
… Eleven items were classified, and 212 healthy students [mean age, 21.0 years; …
NAID 120005642486

Surgery : Anatomical evaluation of hepatic vascular system in healthy beagles using X-ray contrast computed tomography

OISHI Yasuhisa,TANI Kenji,NAKAZAWA Hiroshi [他]
The journal of veterinary medical science 77(8), 925-929, 2015-08
NAID 40020571242

健常人を対象とした1%ブリンゾラミド塩酸塩/0.5%チモロールマレイン酸配合点眼液と1%ドルゾラミド塩酸塩/0.5%チモロールマレイン酸配合点眼液の眼圧下降効果および点眼使用感に関する二重盲検比較試験 (第25回日本緑内障学会)

木村聡,木村亘
あたらしい眼科 32(8), 1191-1195, 2015-08
NAID 40020571194

Related Pictures

★リンクテーブル★

リンク元	「100Cases 33」「健常」
拡張検索	「healthy subject」「healthy men」
関連記事	「health」

「100Cases 33」

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)